From Newsweek "science writer" Sharon Begley, whose medical background appears to begin and end with a bunch of awards from other journalists and a B.A. from Yale University - "Why Doctors Hate Science: Scaremongers warn that 'effectiveness research' threatens the lives of Americans"
Thank God doctors in the United States are free to treat patients as they deem best, free from interference by faceless bureaucrats. If bureaucrats were in charge, physicians might have to prescribe the newest hypertension drugs as a first-line therapy, do MRIs to diagnose back pain and give regular Pap tests to women who have had total hysterectomies. Oh, wait—they do. All these medical practices are common, despite rigorous studies showing how useless or wrongheaded they are. Definitive studies over many years have shown that old-line diuretics are safer and equally effective for high blood pressure compared with newer drugs, for instance, and that MRIs for back pain lead to unnecessary surgery. And those Pap tests? Total hysterectomy removes the uterus and cervix. A Pap test screens for cervical cancer. No cervix, no cancer. Yet a 2004 study found that some 10 million women lacking a cervix were still getting Pap tests.
Well, thank God doctors in the United States don't take their marching orders from journalists - yet. Among the real live doctor responses in the comments...
Her snarky comment "no post-hysterectomy pap smears needed because pap smears are for cervical cancer and there's no more cervix, duh!" is only true for women who have had hysterectomies for benign problems. For women who had hysterectomies because of a prior malignancy, her advice could prove fatal--because 'fatal' is what an undetected recurrence of an invasive cancer in the vaginal cuff would likely be. Similarly her assertion that "diuretics should be first line anti-hypertensive therapy" ignores mucho evidence that diuretics (and beta-blockers) come with significant problems, including a vastly increased risk of triggering diabetes; in light of such evidence, many of the recommendations of JNC 7 are now being reexamined. In short, diuretics are absolutely appropriate therapy for many patients. For others, they're not so great, and even down right dangerous in some case.
Of course, the purpose of the article has little to do with either science or the practice of medicine - the money quote:
It's hard not to scream when you see how many physicians, pharmaceutical companies, medical-device makers and, lately, hysterical conservatives seem to hate science, or at best ignore it. These days the science that inspires fear and loathing is "comparative-effectiveness research" (CER), which is receiving $1 billion under the stimulus bill President Obama signed.
Taking the doctor out of treatment... is there nothing that Obama - and his allies in media - can't do?
Related suggestions - Science 101 for journalists
Via email -
The following is the (scientific) guidelines from the Royal College of Obstetricians and Gynecologists of Canada:
Screening can be discontinued in women who have undergone total hysterectomy for benign causes with no history of cervical dysplasia or human papillomavirus (C-III). Women who have undergone subtotal hysterectomy (with an intact cervix) should continue screening according to the guidelines. - Cancer Care Ontario Royal College of Obstetrics and Gynecology Canada
Please post this in your main post. As well I would advise that this woman be charged with practising and providing medical advice without a medical license. You can write that it comes from me. I have a real medical license to practice in Ontario.
Dr. Caillin Langmann MD PhD
McMaster University Div. Emergency Medicine
Physicians are well respected in the US. If leftist Obama shock troops like this one can tear them down and pave the way to regulating how they practice then there truly is "nothing HE cannot do".
As a medical student, I have this to say: stick with the pen and paper, Sharon. If Physicians hate science so much than why on earth do my profs (REAL doctors, not keyboard jockeys) fill our lectures with study after study after study showing that certain things work and others don't? It's called evidence based medicine, Sharon, and it's what every MD lives by. It's why I get a copy of the Canadian Medical Association Journal every month.
To even *suggest* that doctors "hate science" shows how absolutely ignorant you are of medicine.
She should stick with what she knows. I don't tell you how to do *your* job, Sharon - but it's starting to sound like someone should.
I usually ask my sister before checking with my doctor. Sometimes it saves me a trip to the clinic.
She isn't a doctor, but she stayed in a Holiday Inn Express recently.
I'd have to say you can't pin this one on Obama, because over the last few years I've found that Newsweek is the source of the most idiotic and wrong-headed articles of any mainstream publication.
I really do think the writers at Newsweek are easily the worst by any objective measure. It is truly a rag.
I was talking to an intensivist today - he was saying right now he's looking after people that wouldn't have been admitted to ICU ten years ago. In many cases, it's a extremely futile exercise, but families are pushing for it now more than ever.
Maybe Begley could write an article about how physicians are willfully delivering ICU care, knowing that they are "wasting health care dollars".
And, conservatives hating science - pull-ease - to stereotype, conservatives like facts and evidence, whereas the left runs on feelings and emotions.
Yep, Newsweek always an authoritative journal for medical information.
When she publishes her first peer reviewed medical research article let us know.
Is there a doctor in the house?
Oh, of course there is a shortage of doctors, so we'll quote newsweek.
Cheers
Hans-Christian Georg Rupprecht, Commander in Chief
1st Saint Nicolaas Army
Army Group "True North"
To control my diabetes, I use a drug called Avandimet. It is a combination of two other glucofage drugs, Avandia and Metformin. Beaucoup research indicates for many diabetics Avandimet is significantly more effective than taking Avandia and Metformin separately and seldom less effective. To boot, Avandiamet is cheaper (albeit only marginally)than equal amounts of Avandia and Metformin!
Yet BC Pharmacare will not pay for Avandiamet (it will pay for Avandia and Metformin). Go figure!
to Dante at 12:35: It's good that you recognize that (most of) your profs are firm believers in evidence based medicine. I had thought so about my Engineers profs until I overhead one at a department mixer commenting on how he was willing to disegard his own experiences because what he'd learned wasn't socially acceptable (regarding work ethics amongst visually identifiable groups at a previous workplace). When it's available, you should always look for, and act upon, the raw data. It's nice to see that you're learning proper scientific method (and hopefully the use of Occam's razor) rather than "consensus-based science".
Norm Matthew.-- I thought I had seen this a few days ago.
http://blogs.wsj.com/health/2007/06/12/avandia-lawsuits-emerge-inevitably/
The title of the article indicates the total ignorance of the author about medicine. My background pre-medicine was in pharmacology research and the number of doctors I've seen that don't practice scientific medicine is miniscule.
There appears to be a view among bureacrats that there is a much cheaper way of practicing medicine and diuretics are near the top of the list as they cost pennies/dose. I've got patients who have bp that is well controlled with hydrochlorothiazide (HCTZ), one of the cheapest diuretics. The vast majority of my hypertensive patients are on 3-4 drugs. The reason for this is people don't like to experience side effects from their drugs. With antihypertensive therapy one gets far fewer side effects when one combines multiple drugs in low doses which minimizes side effects but maximizes bp lowering effect. Practicing in a climate where the weather is hot in the summer I take a good number of my patients off diuretics during the summer as they have unacceptable postural hypotension if I don't. HCTZ is a good drug but it is also quite prone to causing allergic reactions and people can develop a rash if exposed to sunlight. If a patient has protein in their urine, then the drug of choice for their elevated bp is an angiotensin receptor blocker or ACE inhibitor. This has been shown in large studies to decrease rate of loss of kidney function.
With antipsychotics, the number of my patients who will willingly take the old typical antipsychotics can be counted on the fingers of one hand. That is why so many schizophrenics are on depot antipsychotic injections. With drugs such as olanzapine people will actually ask for more of the drug as they feel a lot better on it. Yes, olanzapine costs a lot more but it is better to put a patient on a drug that they will take, and get better, than on a dirt cheap drug that they want nothing to do with.
One thing that I haven't seem much mention of in the medical literature is differences in patient populations even in the same province. One common condition I used to see when I was practicing in Vancouver was Vitamin D deficiency and the number of people with undetectable vitamin D levels was scary (of course all of these people dutifully used sunscreen even on rainy days). In my new interior practice vitamin D levels are about 3x higher than in Vancouver and I've had to explain the concept of sunscreen to a number of patients. This will result in different disease incidences as a result and doctors will treat these appropriately.
The underlying premise of idiots who write articles such as the one in Newsweek is that all people are identical and one solution fits all. I was fortunate to have run into a book "Biochemical Individuality" early in my undergraduate studies and it opened my eyes to how vast the differences are among individuals. One of the reasons that we have so many different drugs for treating the same condition is that people respond very differently to what is to the pharmacologically ignorant the "same" drug. Knowing this is part of the art of medicine.
If this keeps up, the word "impertinent" (or "insolent") will make the most-overused list.
Sorry Hans, but for this "journalist" to get a peer reviewed medical research article would be rather easy, especially when her "peers" have as much medical experience as she does.
Damn, I also thought of the Holiday Inn Express line too, but too late.
The underlying difficulty with evidence based medicine is that it's based on group responses to treatment. What's good for the group (i.e., everyone clustered around the mean) is what's promoted. As anyone who has ever seen a normal distribution (bell curve) knows, not everyone clusters around the mean.
As a physician I agree with Loki and Dante. I would also say that it is rare to find any psychiatry patients on the typical antipsychotics for a good reason - they have miserable side effects. I really don't know what she is talking about.
The second most important thing to note is that I'd say almost 100% of my peers use evidence based medicine (I guess similar to the CER she is talking about). MOST of this evidence comes from the United States. In fact when we do our Canadian Treatment Guidelines and Recommendations we usually just copy the U.S. recommendations, really. ie: heart and stroke. Many Canadian prominent physicians and scientists also are involved in writing the U.S. Guidelines.
There is a role for listening to the patient in regards to the types of medications they prefer or have found to work for them. I agree with Loki as from experience I have found some people just respond to different medications differently and I am sure there is a scientific reason behind it which we will one day discover but in the meantime I am not listening to the State or insurance companies to tell me what to do.
The Insurance Companies are behind evidence based medicine as well...
She's just a typical press mouthpiece for Obama. Evidence based medicine wasn't discovered by Obama just like the internet wasn't created by Al Goreacle but we can all see where this is going.
The real lack of scientific training is best demonstrated among journalists---Especially as to educational and other social service programs: For which see my blog under "Science".
...this is my affydavid that i am not now nor have i ever been related...married or associated in any manner genetically or otherwise with this sharon "begley' character.
...dear friends...i smell a conspiracy...a warped twisted demented lllieberal attempt to smear my good name and bona fides as a confirmed irremediable right wing fascist...this ploy reeks of a certain feline fancier's filthy machinations...
loki
"""""Biochemical Individuality" """""
thanx for that title
I'm not in medicine but that book peeks my interest, as I find that many people don't view people at a "chemical" level!!
In the US, much of the so called excessive and unnecessary procedures that doctors perform is directly related to the excessive amount of liability lawsuits. I think the influence of the American Trial Lawyers on medicine is of much bigger impact and concern. Doctors are scared that they will be sued for missing anything so they order the tests - especially when it is covered by the insurance provider.
Yeah, conservatives HATE science. That's why so many of us go into professions like teaching, journalism, social work, unionized industry, . . . OOOPS. Sorry, my mistake. You're more likely to find conservatives in geology, physics, engineering, chemistry, etc. You know, those "hard" courses at University.
I know of no group in our society that works harder than MD's including specialists. The patient time is only part of it. There is a vast quantity of "science based" journals to read, consultation with those with a better understanding of a problem is kinda like lernin. The conferences are usually in nice places with seminars and a round of golf.. earned. That is common in government. Patient files to update. Nope I'll pick on journalists instead. By the way, MD is more than a three year course and kinda science based.
As a physician I would like to WARN readers of this article who have had a hysterectomy that the scientific evidence based recommendations for pap smears are as follows:
Screening can be discontinued in women who have undergone total hysterectomy for benign causes with no history of cervical dysplasia or human papillomavirus (C-III). Women who have undergone subtotal hysterectomy (with an intact cervix) should continue screening according to the guidelines. - Cancer Care Ontario Royal College of Obstetrics and Gynecology Canada
I just notice in her article that she gives advice that is wrong and could lead to unecessary death.
Langmann MD PhD
Without sounding patronizing I would suggest the medical types review the recent work of Dr. Marcie Angel, long time editor of the NEJM (New England Journal of Medicine, arguably the world's most honored medical journal.) She has followed up her 2004 book "The Truth About the Drug Companies, and What to do about it" with many op eds and papers about the brothel that medical research is.
When the peer journals are captured, when the research funding is captured and when the chairs at all the major Universities are captured, when the text book publishers are captured and when "best evidence" is arbitrarily defined as which drug sales most benefit stock prices at the casino, sorry Wall St. you get what we've got.
This is not to indict the many caring doctors who do provide excellent primary care and tremendous emergency care, but to ask them to recognize that the incentive for public companies to fudge evidence to boost sales is irresistable. The tens of billions paid in "no fault settlements" to FTC and FDA over the past couple of years by major drug firms should be a heads up.
I think the lesson here is for women to not be so quick to give up their cervix to the first guy who comes down the road. Whatever.
I second most of the comments above. The problem with Begley's reasoning is the application of population statistics to a given individual within that population. It's akin to saying that because the average shoe size within the population is size 9 1/2 we'll give everyone size 9 1/2 shoes and everyone will be happy. Wrong! Population statistics only tell you the likelihood that a first attempt at treatment/or diagnosis will work or get you the right diagnosis. But as someone once put it "But there's only one Mrs. Jones and she's the one in my office."
Side effects, patient anxiety, medico-legal threat perpetuated by the likes of the American Trial Lawyers' Association (one of the largest if not the largest single contributor to the Democratic Party year after year -- can you say "John Edwards"?) all skew the therapeutic decision making process. The ultimate kicker is of course, that if physicians treat strictly according to Begley's "scientific medicine" guidelines her next diatribe will be titled, "Doctors are Uncaring, Unfeeling, Impersonal Technocrats".
PBinWA: very true. Litigious patients in the united states have forced many american physicians to practice 'defensive medicine,' i.e. usually unnecessary testing or procedures in order to rule out unlikely diagnoses and protect themselves from litigation resulting from a possible missed diagnosis.
It's clear what she's saying, government bureaucracy is the new "science".
My personal Phantom swing of the cluebat: you can't diagnose back pain with an MRI. Anybody who thinks you can is a moron.
GYM Biochemical Individuality by Roger Williams is well worth reading. It was published in 1956 and recently reprinted. When I re-read it a few years back I realized that it had a huge effect on how I now practice medicine.
It's interesting to see how every physician who hangs out on SDA has the same individualistic approach to medicine. The practice of medicine involves a large number of N=1 clinical trials where the response of individual patients to various drugs is measured and doses/individual drugs are adjusted until a desired response is obtained. Population based studies only serve as a starting point.
I like DrD's shoe size analogy and patients are as likely to frequent a physician who treats patients based on population statistics as they are to frequent a shoe store that only sells size 9 1/2 shoes.
What's funnier, Kate, is that your education amounts to painting copyrighted warner bros characters on motorcycle helmets, yet you seemingly purport to be an expert on complex issues from climate science to macro economics. lol.
Tit for tat, honey.
I do, Wanda? Source, please.
Lucy, stat you?
Making commentary does not make you an expert. What I've seen on her blog is mostly outside expert opinion with sources to back it up. The way it should be.
That's the point of this one blog entry. The journalist presented herself as an expert, and it's pretty obvious she isn't.
Wanda wrote:
"What's funnier, Kate, is that your education amounts to painting copyrighted warner bros characters on motorcycle helmets, yet you seemingly purport to be an expert on complex issues from climate science to macro economics. lol.
Tit for tat, honey."
Well sweetie, I can't play bagpipes...but I can establish whether you can just by listening.
You are off key.........
It's simple: talk to your doctor. No opinions column or article on the Internet can supplant a doctor's knowledge and experience. Ask questions if you must but at the end of the day a caring physician will look out for you. I qualify this with the word "caring" because I've seen some physicians (and nurses) who couldn't care less about patients. I've also seen some really good ones (my hat is off to you).
Peter, I'd sooner take medical policy advice from Newsweek than NEJM. They have had their own scandals in matters of pharma influence and quality of studies published. I gave up on them long ago. Newsweek too, of course.
Hey Wanda, MY education amounts to a Masters in Physical Therapy. I can tell you Kate's observations here are right friggin' on. Or perhaps you could read the comments by langmann above. Or any of the other expert comments above.
My comment that you can't diagnose back pain with an MRI is true. Its also true that back pain generally is a hideously complex area, because nobody really understands how it works. Not PTs, not surgeons, not chiropractors, nobody. The -studies- on back pain range from pitiful to inconclusive. Inconclusive is the -good- end of the curve, Wanda. Inconclusive is what an honest person writes when they don't know for sure how something works.
What this Begley woman is advocating is a manufacturing model. In manufacturing you try to figure out the most efficient way to make something. One of the unstated assumptions in manufacturing is that all the inputs from raw material to labour can be assumed to identical. On average, one welder will produce the same ammount of work as another. On average, one piece of pipe or pound of flower is the same as every other. Each finished car or loaf of bread is as close to identical as can be arranged. This is the purpose of mass manufacturing.
Now, let us apply this assumption to medicine. In studying the outcomes of a single procedure such as the total hip replacement, can we assume the raw material, that being the patients, are identical? Same fitness, same age, same weight, same mental acuity, same level of compliance with instruction? Can we assume that the labour, as in the surgical team, is on average the same? Can we assume the abilities of the after surgery staff average out?
Well, can we Wendy? Because that's what those studies DO assume, and that's why people like me and langmann and Kate shake our heads when people like Sharon frickin' Baley get up on their high horse and start braying about how stupid doctors can't stand science.
Look up DRGs some time. That's Diagnostic Related Group. DRG is the de-facto standard for payment used by insurance companies in the USA to pay hospitals, doctors and etc. for their work. DRGs assume every hip replacement is the same as every other, every surgeon is the same as every other. Why? Because its in the interests of the insurance companies to do it that way, not because it -is- that way.
This boils down to a political argument in the end, because it is not a scientific one. The truth of the matter is that 90% of the "research" one finds on many subjects in the medical literature is complete crap.
Anybody who makes clinical decisions based on the "latest research" is cracked. You make clinical decisions based on your own skill and experience, and anybody who tries to make you do otherwise is not your friend. Or the patient's friend either.
Hey Wanda-
Kate did not portray herself as an expert-- simply passed on factual information. What Kate does is prove that there IS intelligent life in this universe,evidence of which today is much in question.And besides -could you paint a hockey helmet ? I have trouble spelling it.-- Roni on Windows98{tm} with one finger. Keeps me short. Don't get me mad or I switch to a different finger!!
I think that maybe the a$$wipe journalist is just preparing the Americans for the loving care, stand in line, waiting lists to even see a doctor that the Canadians have. It's called medicare. It was promised by the big 'o' in the election.
Proving yet again that the Members of the MSM are by and large.... as a group ... the most ignorant and dishonest people on the planet.
Pimps... whores ... drug dealers ALL outrank Mainstream Media in ethics and accountability.
I went back and read it again, and found the tat, for a while I only had the tit.
Wanda,
Is your broom a push start or a pull start?
Wow Kate, you got results again.
Hannibal ROFL, her's is floated by obamagisms and pure hate of rational thinkers.
What a piece of tripe.